Provider Demographics
NPI:1346752623
Name:SOUTHWEST BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHWEST BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:SACE 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-257-9339
Mailing Address - Street 1:3450 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2331
Mailing Address - Country:US
Mailing Address - Phone:602-257-9339
Mailing Address - Fax:602-265-8533
Practice Address - Street 1:1255 W BASELINE RD STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5821
Practice Address - Country:US
Practice Address - Phone:480-820-5422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033923Medicaid